American Medical News
By — Posted July 22, 2013
When describing the importance of patients having access to their medical records, Keith Veselik, MD, director of primary care at Loyola University Health System in Maywood, Ill., likes to give an example.
One of his patients was flying from Chicago to Boston and started experiencing chest pain. After landing, the man was transferred to the nearest hospital. Once there, the patient pulled out his smartphone, opened his myLoyola app (the health system's patient portal) and handed the phone to the emergency physician examining him.
The app gave the doctor a medication list, a problem list, a history of tests and procedures and other relevant information that not only helped the doctor treat his patient but also prevented unnecessary tests.
When talk of a nationwide health information exchange began several years ago, proponents used stories like this to gain support for the idea. Without electronic information exchange, they argued, the physicians would have to rely on a patient's memory or waste critical time digging for the right information. Back then, however, few imagined that patients could facilitate the exchange of information.
But as the capabilities of patient portals continue to grow beyond a tool meant simply to engage patients by informing them of their health status, the concept of an “HIE of one” is starting to take hold. Putting all the data in patients' hands, and empowering them to decide where and with whom the data can be shared, is not only a giant step forward in patient empowerment, it can be an advantage to physicians.
There's been much debate about the best ways to protect patient privacy while giving physicians the ability to access the information they need to do their jobs. Part of the problem has been the technical difficulties that would allow patients to decide whom to share their data with and what specifically would be shared. Many of these challenges are starting to be addressed by HIE organizations, but the consent process often creates a lag in data access. Through patient-controlled portals, physicians have the ability to receive crucial information when they need it — at the point of care.
If Dr. Veselik's patient in Boston did not have access to his patient portal, physicians treating him would have had to contact Loyola, wait for someone to respond and then send the data — steps that would have taken an emergency physician too much time. The time crunch could have led to the duplication of tests the patient already received in Chicago in an attempt to find the diagnostic answers in a short amount of time.
Even in nonemergency settings, physicians often have to play a game of phone or email tag, combined with a patient consent process, to get patient information in their hands. Through the portals, consent isn't an issue because the patient facilitates the exchange, making the consent implied.
“You reduce the need to set up a whole process around contacting the patient to get their consent, then contacting the provider to share the consent the patient just gave me, to request the information from that provider then be sent to this provider,” said Jeanette Polaschek, director of change management for Orion Health, a health IT software company in Santa Monica, Calif., that develops patient portal technology. “So there's this complex chain of emails and phone conversations that exists in offices and hospitals throughout the U.S. today that could be replaced by simply empowering the patient to have their own information that's been provided to them by the physician that is accurate and complete and tells the story that another provider can take to provide care to the patient.”
Dr. Veselik said, “Many patients receive care from multiple care settings.” It's not uncommon for patient data to come to him the day after he has already seen the patient, he said.
When “personal health records” became a buzz term several years ago, physicians balked at using data provided by patients, citing concerns about not knowing the source of the data, the accuracy of patient-reported information and the disparate formats used for documentation. Personal health records morphed into patient portals and alleviated many of those concerns because portals serve as a repository of the data found within a physician's EHR as opposed to information reported by patients.
“With today's technology and standards, you can identify where the information came from, the source, what provider was involved in that care or if it was generated by the patients themselves,” Polaschek said. Physicians can consider the source and weigh how they can use it to make decisions.
The interoperability standards also make it possible for physicians to take information that originated from another health care organization and make it a part of their records, said Bruce Burstein, MD, chief medical informatics officer for veEDIS, an emergency department EHR developer in Plantation, Fla., that is launching a patient portal.
Experts say although the “HIE of one” can be a powerful data exchange tool, it should be viewed only as a supplement to the physician-facilitated exchange of patient information.
Part of good patient care is getting the right information necessary to provide care, Polaschek said. Physicians have an obligation to seek out the information they need and not place that burden on the patient. They are adopting tools that will make this easier for them.
Patients also could deem some pieces of information unimportant and decide not to share them. Or there may be data that patients don't want their physicians to see, said Daniel Newman, MD, CMIO of MEDfx, a medical technology vendor in Warwick, R.I. Therefore, physicians need to be proactive about gathering all relevant information from multiple sources. The patient portal is just one of the many tools at a physician's disposal. (See correction)